A new approach to managing patients with problematic metal hip implants: the use of an Internet-enhanced multidisciplinary team meeting

2.50
Hdl Handle:
http://hdl.handle.net/10547/582819
Title:
A new approach to managing patients with problematic metal hip implants: the use of an Internet-enhanced multidisciplinary team meeting
Authors:
Berber, Reshid; Pappas, Yannis ( 0000-0003-3087-860X ) ; Khoo, Michael; Miles, Jonathan; Carrington, Richard; Skinner, John; Hart, Alister
Abstract:
Background: Over one million patients worldwide are estimated to have a metal-on-metal hip arthroplasty. To improve the management of these patients and reduce surgeon uncertainty regarding decision-making, we designed an Internet-enhanced multidisciplinary team (iMDT) working approach. Methods: From August 2012 to April 2014, the iMDT discussed 215 patients with 266 metal-on-metal hip arthroplasties. Of these, 236 primary arthroplasties (132 hip resurfacing and 104 total hip) were analyzed. The remaining thirty cases involved problematic revised hips and were therefore excluded. The possible recommendations of the iMDT were monitoring, further investigation, or surgery. The concordance between the recommendation and the actual management was used to assess the usefulness of this approach in reducing uncertainty in surgeon-level decision-making. Results: The median Oxford Hip Score was 35 (range, 4 to 48), and median cobalt and chromium levels in whole blood were 3.54 ppb (range, 0.18 to 161.46 ppb) and 3.17 ppb (range, 0.20 to 100.67 ppb), respectively. Magnetic resonance imaging revealed abductor muscle atrophy in ninety-two (39%) of the hips and a pseudotumor in eighty (34%). The iMDT recommended monitoring of 146 (61.9%) of the hips, further investigation of thirty (12.7%), and surgery in sixty (25.4%). The actual outcome was concordant with the recommendation in 211 (91.7%) of the hips. Conclusions: Our iMDT approach to the metal-on-metal hip burden combines the tacit knowledge of an expert panel, regulatory guidance, and up-to-date evidence to improve decision-making among surgeons. The high level of concordance between the recommendation and the actual outcome, combined with the feasibility of the methods used, suggest that this method effectively reduces uncertainty among surgeons and may lead to improved patient outcomes.
Affiliation:
Royal National Orthopaedic Hospital; University of Bedfordshire
Citation:
Berber, R., Pappas, Y., Khoo, M., Miles, J., Carrington, R., Skinner, J., Hart A. (2015) 'A New Approach to Managing Patients with Problematic Metal Hip Implants: The Use of an Internet-Enhanced Multidisciplinary Team Meeting'. The Journal of Bone & Joint Surgery, 97(4), e20.
Publisher:
British Editorial Society of Bone & Joint Surgery
Journal:
The Journal of bone and joint surgery. American volume
Issue Date:
18-Feb-2015
URI:
http://hdl.handle.net/10547/582819
DOI:
10.2106/JBJS.N.00973
PubMed ID:
25695991
Additional Links:
http://jbjs.org/content/97/4/e20.long; http://www.ncbi.nlm.nih.gov/pubmed/25695991
Type:
Article
Language:
en
ISSN:
1535-1386
Appears in Collections:
IHR Institute for Health Research

Full metadata record

DC FieldValue Language
dc.contributor.authorBerber, Reshiden
dc.contributor.authorPappas, Yannisen
dc.contributor.authorKhoo, Michaelen
dc.contributor.authorMiles, Jonathanen
dc.contributor.authorCarrington, Richarden
dc.contributor.authorSkinner, Johnen
dc.contributor.authorHart, Alisteren
dc.date.accessioned2015-11-27T12:05:57Zen
dc.date.available2015-11-27T12:05:57Zen
dc.date.issued2015-02-18en
dc.identifier.citationBerber, R., Pappas, Y., Khoo, M., Miles, J., Carrington, R., Skinner, J., Hart A. (2015) 'A New Approach to Managing Patients with Problematic Metal Hip Implants: The Use of an Internet-Enhanced Multidisciplinary Team Meeting'. The Journal of Bone & Joint Surgery, 97(4), e20.en
dc.identifier.issn1535-1386en
dc.identifier.pmid25695991en
dc.identifier.doi10.2106/JBJS.N.00973en
dc.identifier.urihttp://hdl.handle.net/10547/582819en
dc.description.abstractBackground: Over one million patients worldwide are estimated to have a metal-on-metal hip arthroplasty. To improve the management of these patients and reduce surgeon uncertainty regarding decision-making, we designed an Internet-enhanced multidisciplinary team (iMDT) working approach. Methods: From August 2012 to April 2014, the iMDT discussed 215 patients with 266 metal-on-metal hip arthroplasties. Of these, 236 primary arthroplasties (132 hip resurfacing and 104 total hip) were analyzed. The remaining thirty cases involved problematic revised hips and were therefore excluded. The possible recommendations of the iMDT were monitoring, further investigation, or surgery. The concordance between the recommendation and the actual management was used to assess the usefulness of this approach in reducing uncertainty in surgeon-level decision-making. Results: The median Oxford Hip Score was 35 (range, 4 to 48), and median cobalt and chromium levels in whole blood were 3.54 ppb (range, 0.18 to 161.46 ppb) and 3.17 ppb (range, 0.20 to 100.67 ppb), respectively. Magnetic resonance imaging revealed abductor muscle atrophy in ninety-two (39%) of the hips and a pseudotumor in eighty (34%). The iMDT recommended monitoring of 146 (61.9%) of the hips, further investigation of thirty (12.7%), and surgery in sixty (25.4%). The actual outcome was concordant with the recommendation in 211 (91.7%) of the hips. Conclusions: Our iMDT approach to the metal-on-metal hip burden combines the tacit knowledge of an expert panel, regulatory guidance, and up-to-date evidence to improve decision-making among surgeons. The high level of concordance between the recommendation and the actual outcome, combined with the feasibility of the methods used, suggest that this method effectively reduces uncertainty among surgeons and may lead to improved patient outcomes.en
dc.language.isoenen
dc.publisherBritish Editorial Society of Bone & Joint Surgeryen
dc.relation.urlhttp://jbjs.org/content/97/4/e20.longen
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pubmed/25695991en
dc.rightsArchived with thanks to The Journal of bone and joint surgery. American volumeen
dc.subjectarthroplastyen
dc.subjecthip arthroplastyen
dc.subjectteam workingen
dc.subjectmultidisciplinary groupsen
dc.subjectInternet-enhanced multidisciplinary teamen
dc.subject.meshAtrophyen
dc.subject.meshChromiumen
dc.subject.meshCobalten
dc.subject.meshDiagnosis, Differentialen
dc.subject.meshEquipment Failure Analysisen
dc.subject.meshGreat Britainen
dc.subject.meshHip Prosthesisen
dc.subject.meshHumansen
dc.subject.meshInterdisciplinary Communicationen
dc.subject.meshInterneten
dc.subject.meshJoint Diseasesen
dc.subject.meshMagnetic Resonance Imagingen
dc.subject.meshMuscle, Skeletalen
dc.subject.meshPatient Care Teamen
dc.subject.meshProsthesis Designen
dc.subject.meshProsthesis Failureen
dc.subject.meshRisk Assessmenten
dc.subject.meshSocial Mediaen
dc.titleA new approach to managing patients with problematic metal hip implants: the use of an Internet-enhanced multidisciplinary team meetingen
dc.typeArticleen
dc.contributor.departmentRoyal National Orthopaedic Hospitalen
dc.contributor.departmentUniversity of Bedfordshireen
dc.identifier.journalThe Journal of bone and joint surgery. American volumeen

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